START: The Injury Prevention Programme Set to Make A Real Difference to the Joint Health of Young People

Nick London shares his pride in the graduation of Tom Hughes, the PhD student he’s been supporting in developing an injury prevention programme for UK schools and sports, a programme which may finally succeed where others have failed.

Towards the end of last year, I shared news about a research project I initiated through The Yorkshire Knee Clinic and in my capacity as Visiting Professor of Sports Medicine to the Leeds Beckett University Carnegie School of Sport. It’s important research aimed at addressing the issue of ACL (anterior cruciate ligament) injury in young people by helping to define and unlock some of the barriers to the introduction of cruciate injury prevention programmes within schools.

> You can read the post here.

Then, Tom Hughes, the research student we appointed, had shared the first report from his research. I’m delighted to say that Tom proved to be a magnificent appointment and this summer he successfully graduated as a PhD having delivered an outstanding project which we hope will make a real difference to the experiences and joint health of young athletes. I am enormously proud to have been involved at the beginning and throughout.

It has certainly been a challenging journey. I attracted start-up funds in early 2020 (which were more than matched by Leeds Beckett University). Expertly guided by his supervisors, Professor John O’Hara and Dr Stacey Emmonds, Tom set about planning the project.

Then came Covid.

Change of plan

Tom’s original plan was to look at the incidence of ACL injuries among young people and develop a programme that would be deliverable within schools. That meant developing a 10-minute programme that could reasonably fit into a typical PE lesson.

It’s an obvious challenge to develop a research programme based on school sports when the schools are closed, and there were dark months during the early stages of the project when Covid meant that things would be stalled for months. It became clear that the original plan would be undeliverable. Even when children returned to sport, they wouldn’t represent a ‘normal’ population suitable for study because their enforced time out of sport may have made them more susceptible to injury.

Injury prevention in four parts

After much consideration, Tom redesigned his PhD into four studies. One, a review of the existing literature, is a part of all PhDs. The second part was a genius ‘pivot’ to examining the barriers to introducing an injury prevention programme into UK schools and sports.

Tom interviewed large numbers of PE teachers and found that a combination of lack of time, cultural sensitivity (on the part of non-schools-based researchers) and training in injury prevention were some of several issues that needed to be overcome in order to successfully introduce any knee injury programmes into schools.

Study three returned to the issue of redesigning a programme that could be delivered in 10 minutes. Tom used Delphi methodology, a powerful, structured technique which involved asking a set of questions to a pool of experts in Australia, the US, UK and Europe.

Would the injury prevention programme need to be different for males and females? Should it be sport specific? Would the 10 minutes be filled with lots of different exercises with a small number of repetitions, or more repetitions of a smaller number of exercises?

The experts’ experience meant they were able to offer different insights and perspectives which enabled Tom to build consensus around a programme capable of being delivered in the real world by PE teachers.

> Discover more about children’s knee injuries
> Discover more about ACL injuries

Developing START

For the fourth study, Tom took his findings to PE teachers and, together, they incorporated the research in a practical, deliverable programme. The result was START – strength, tension (core exercises), aerial (jumping and landing ), reaction (focusing on change of direction, which is a major factor in ACL injuries), and technique.

Each element is supported by a range of specific exercises, giving PE teachers the flexibility and freedom to mix the programme and keep it interesting while achieving consistent results.

“Autonomy in PE teaching is a critical element of success,” explains Tom. “PE teachers are passionate about what they do and want to get the best out of the kids they work with, but while they will constantly look for new strategies to support their work among their peers, they’ve been traditionally less enthusiastic about research from outside the school environment.
So it was extremely important that we brought the teachers with us and gained their buy-in. The range of exercises available through START is just one way that we’ve listened to teachers and ensured that they remain in full control of their lessons.

“Initial reactions from the teachers we’ve worked with have been that START has made the beginning of PE lessons more constructive. We’re now setting out to study the full effects of the programme.”

Tom believes that, “The START programme has real promise and may be able to succeed where other programmes have failed, by appreciating the complexity of schools and the critical role teachers play.”

Bringing START into schools

The project’s outcomes have been met with enthusiasm from some highly influential figures, including now former England manager Gareth Southgate and Baroness Sue Campbell, retiring Director of Women’s Football at the FA and former Chair of UK Sport.

Theirs and others’ influence will be important because, as Tom notes: “The next stage needs to widen the net and incorporate a range of schools into the design process. At the same time this will upskill teachers in injury prevention, which will propagate throughout the profession.”

It has been an enormous challenge to bring this PhD over the line, given the obstacles with which Tom was faced. But he and I are optimistic that, rather ironically, an enforced period away from sport could have inadvertently been the catalyst for a profound change in our ability to protect children’s ACLs now that they have returned to track, pitch, field and court.

We’ll share more about the progress of START in due course. Meanwhile, if your child has injured their knee during sport, please contact us or phone us on 03453 052 579.

> Discover more about Nick London
> Discover more about children’s knee injuries
> Discover more about ACL injuries